Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm Cryoballoon

Metzner, Andreas; Burchard, Andre; Wohlmuth, Peter; Rausch, Peter; Bardyszewski, Alexander; Gienapp, Christina; Tilz, Roland Richard; Rillig, Andreas; Mathew, Shibu; Deiß, Sebastian; Makimoto, Hisaki; Ouyang, Feifan; Kück, Karl‐Heinz; Wißner, Erik

doi:10.1161/circep.113.000228

Cited by 137 publications

(125 citation statements)

References 18 publications

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“…The incidence of esophageal thermal injury after PVI using the 28-mm second-generation cryoballoon ranges between 12% and 19%. 8,9 Based on these results, safety cut-offs for the intraluminal esophageal temperature were developed to reduce the risk of esophageal thermal injury. 8,9 The incidence of PN palsy during second-generation cryoballoon-based PVI was reported as high as 19.5%.…”

Section: Figurementioning

confidence: 99%

“…8,9 Based on these results, safety cut-offs for the intraluminal esophageal temperature were developed to reduce the risk of esophageal thermal injury. 8,9 The incidence of PN palsy during second-generation cryoballoon-based PVI was reported as high as 19.5%. 6 At our center, the rate is 3.5% 7 and thus comparable to the first-generation cryoballoon.…”

Section: Figurementioning

confidence: 99%

“…Initial acute and mid-term clinical results have been published, reporting an improvement in efficacy compared with the first-generation cryoballoon. 4,5 Furthermore, the rate of phrenic nerve (PN) palsy 6,7 and esophageal thermal injury 8,9 has been described. However, 1-year clinical outcome after PVI using the secondgeneration 28-mm cryoballoon has not yet been reported.…”

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confidence: 99%

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One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Metzner

Reißmann

Rausch

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

mentioning

confidence: 99%

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One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Metzner

Reißmann

Rausch

et al. 2014

Circ: Arrhythmia and Electrophysiology

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202

145

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“…The intraluminal esophageal temperature cut-off was set to 10°C according to previous evaluations. 9 During ablation of the septal PVs, continuous phrenic nerve pacing at maximum output and pulse width (12 mA, 2.9ms) at a cycle length of 1200 ms was performed using a diagnostic catheter positioned in the superior vena cava. Phrenic nerve capture was monitored by tactile feedback of diaphragmatic contraction and registration of the compound motoric activation potential of the right diaphragm.…”

Section: Intraprocedural Managementmentioning

confidence: 99%

Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

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The regular TS was exchanged over a guidewire for a 12F steerable TS (Flexcath Advance, Medtronic Inc., Minneapolis, MN). The © 2015 American Heart Association, Inc. Original ArticleBackground-The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. Methods and Results-A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St.George's hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful secondgeneration 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131-357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found (P=0.0002). Conclusions-The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.

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“…Although recent studies showed that the efficacy and safety of CB‐PVI is similar to that of radiofrequency ablation, the follow‐up duration rarely exceeds 2 or 3 years. In contrast, recent reports suggested new complications of CB‐PVI such as PV stenosis and bronchial and esophageal injury 23, 24, 25. Consequently, we believe that further research on the mechanisms of CB‐PVI and longer follow‐up are needed.…”

Section: Discussionmentioning

confidence: 83%

Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS‐Cryo Study

Lewandowski

Smarż

Sikorska

et al. 2017

JAHA

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BackgroundCryoballoon‐based pulmonary vein isolation (CB‐PVI) has been widely used for the treatment of atrial fibrillation. Although generally safe and effective, the procedure may be associated with pulmonary vein (PV) stenosis and bronchial or esophageal injury. The mechanisms leading to these complications have not been studied in detail. Our aim was to examine acute effects of cryoballoon on the pulmonary vessel and right heart pressures as well as PV wall morphology.Methods and ResultsIn 8 patients (5 men, mean age 55±14 years) undergoing CB‐PVI, pressure in each PV was measured by catheter located inside the PV directly before and after CB‐PVI. The right atrial, right ventricular, and pulmonary artery pressures as well as pulmonary arterial wedge capillary pressure in the pulmonary artery branch corresponding to target PV were also measured. Morphological changes in PVs were assessed using intravascular ultrasonography.There were no significant differences in PV pressures before and after ablation. The pulmonary arterial wedge capillary pressure significantly increased during cryoapplication (left superior: 20±10 versus 29±8.5 mm Hg, P=0.004; left inferior: 24±10 versus 32±6 mm Hg, P=0.012; right superior: 25±9 versus 35±10 mm Hg, P=0.002; right inferior: 24±10 versus 37±12 mm Hg, P=0.0036). The right atrial and pulmonary artery pressures increased significantly after CB‐PVI (9±6 versus 13±8 mm Hg, P=0.004, and 20±9 versus 24±10 mm Hg, P=0.048, respectively). Intravascular ultrasonography showed acute edema and dissection‐like changes causing relative lumen narrowing in 90% of PVs.Conclusions CB‐PVI causes significant rise in pulmonary artery and right atrial pressures as well as PV wall damage. The clinical significance of these findings warrants further investigations.

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Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm Cryoballoon

Abstract: Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.

Cited by 137 publications

References 18 publications

One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Once Isolated, Always Isolated?

Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS‐Cryo Study

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